Geriatric Transitional Care for Older Patients Discharged From the Emergency Department: Impact on Early Readmissions
Trial Parameters
Brief Summary
Elderly adults have high rates of emergency department (ED) visits. Specificities of this population challenge organizations of care in the ED, and older adults are at risk of pejorative outcomes after an ED stay. Numerous interventions have been designed to improve quality of care and outcomes for the older population in these settings, with a specific attention to concerning discharge from the ED. These interventions are interdisciplinary, bridging emergency and geriatric care. The wide range and complexity of these interventions make them difficult to assess and compare, as highlighted by several reviews in the past ten years. Prior analyses helped to categorize different intervention strategies and three main designs: inhospital, community and transitional interventions started in the ED and pursued in collaboration with community primary care professionals . Theses analyses show that the use of multiple strategies and transitional models of care tend to lead to better outcomes, and underline that more robust studies are needed to confirm this hypothesis. In France a majority of EDs collaborate with Geriatric Mobile Teams (GMT) to improve quality of care for older patients. GMTs are dedicated to patients over 75 years old, and interventions in EDs are targeted on patients at risk of worse outcome. When ED physicians detect older patients at risk they may call for the GMT for further assessment and management. GMTs either work in a inhospital standard approach or with a transitional care management. This second strategy, less common in France, is thought to be be efficient and has never been assessed. We have designed a study to compare these methods, with the hypothesis that among at-risk older adults, hospital-community transition care initiated by GMTs during an ED visit with direct discharge home will be associated with a reduction in the risk of early readmission within 30 days, and lower risk of loss of independence at 3 and 6 months. It is a french multicentric study, with a quasi-experimental design, comparing hospitals without transitional care management to hospitals with hospital-community transitional intervention. We aim at enrolling 1322 patients aged 75 and more at risk of pejorative outcomes as determined by the Triage Risk Screening Toll (TRST). The main outcome is a revisit to the ED between day 7 and day 30, secondary outcomes are autonomy, mortality, use of hospital services and caregiving at home at 6 months.
Eligibility Criteria
Inclusion Criteria: * Patient admitted to the emergency departement over 75 years old and living at home (including independent residence) * Patient admitted to the Emergency Reception Service (ERS) for less than 48 hours for whom a return home has been decided * Identified at risk of readmissions to the emergency departement with a Triage Risk Screening Tool (TRST) score \> 2. * Consent to the study possible at the time of his visit to the emergency room by the patient or a caregiver present at the time of inclusion. * Patient affiliated with a social security (beneficiary or partner) Exclusion Criteria: * Person living in an nursing home * Severe cognitive impairment according to DSM V criteria and absence of a close relative at the time of inclusion * Unstabilized psychiatric pathology and absence of relatives at the time of inclusion * Language barrier and absence of relatives at the time of inclusion * Person under guardianship, under legal safeguard measure, deprived of liberty b